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Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes?
Drug Alcohol Depend. 2019 Jun 01; 199:70-75.DA

Abstract

INTRODUCTION

Substance use disorders (SUD) frequently co-occur with posttraumatic stress disorder (PTSD). Little is known, however, about how individuals with a single SUD diagnosis (relating to only one substance) compare to individuals with poly-SUD diagnoses (relating to more than one substance) on substance use and PTSD treatment outcomes. To address this gap in the literature, we utilized data from a larger study investigating a 12-week integrated, exposure-based treatment (i.e., Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure, or COPE) to examine treatment outcomes by single vs. poly-SUD status.

METHOD

Participants were 54 Veterans (92.6% male, average age = 39.72) categorized as having single SUD (n = 39) or poly-SUD (n = 15). T-tests characterized group differences in baseline demographics and presenting symptomatology. Multilevel models examined differences in treatment trajectories between participants with single vs. poly-SUD.

RESULTS

Groups did not differ on baseline frequency of substance use, PTSD symptoms, or treatment retention; however, individuals with poly-SUD evidenced greater reductions in percent days using substances than individuals with a single SUD, and individuals with a single SUD had greater reductions in PTSD symptoms than individuals with poly-SUD over the course of treatment.

DISCUSSION

The findings from this exploratory study suggest that Veterans with PTSD and co-occurring poly-SUD, as compared to a single-SUD, may experience greater improvement in substance use but less improvement in PTSD symptoms during integrated treatment. Future research should identify ways to enhance treatment outcomes for individuals with poly-SUD, and to better understand mechanisms of change for this population.

Authors+Show Affiliations

Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA. Electronic address: jeffirs@musc.edu.Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA; Ralph H. Johnson VA Medical Center, 109 Bee St., Charleston, SC, 29401 USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31009834

Citation

Jeffirs, Stephanie M., et al. "Veterans With PTSD and Comorbid Substance Use Disorders: Does Single Versus Poly-substance Use Disorder Affect Treatment Outcomes?" Drug and Alcohol Dependence, vol. 199, 2019, pp. 70-75.
Jeffirs SM, Jarnecke AM, Flanagan JC, et al. Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes? Drug Alcohol Depend. 2019;199:70-75.
Jeffirs, S. M., Jarnecke, A. M., Flanagan, J. C., Killeen, T. K., Laffey, T. F., & Back, S. E. (2019). Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes? Drug and Alcohol Dependence, 199, 70-75. https://doi.org/10.1016/j.drugalcdep.2019.04.001
Jeffirs SM, et al. Veterans With PTSD and Comorbid Substance Use Disorders: Does Single Versus Poly-substance Use Disorder Affect Treatment Outcomes. Drug Alcohol Depend. 2019 Jun 1;199:70-75. PubMed PMID: 31009834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes? AU - Jeffirs,Stephanie M, AU - Jarnecke,Amber M, AU - Flanagan,Julianne C, AU - Killeen,Therese K, AU - Laffey,Taylor F, AU - Back,Sudie E, Y1 - 2019/04/09/ PY - 2018/10/15/received PY - 2019/3/28/revised PY - 2019/4/2/accepted PY - 2019/4/23/pubmed PY - 2019/12/25/medline PY - 2019/4/23/entrez KW - PTSD KW - Polysubstance use KW - Posttraumatic stress disorder KW - Prolonged exposure KW - Substance use disorder KW - Treatment outcome SP - 70 EP - 75 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 199 N2 - INTRODUCTION: Substance use disorders (SUD) frequently co-occur with posttraumatic stress disorder (PTSD). Little is known, however, about how individuals with a single SUD diagnosis (relating to only one substance) compare to individuals with poly-SUD diagnoses (relating to more than one substance) on substance use and PTSD treatment outcomes. To address this gap in the literature, we utilized data from a larger study investigating a 12-week integrated, exposure-based treatment (i.e., Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure, or COPE) to examine treatment outcomes by single vs. poly-SUD status. METHOD: Participants were 54 Veterans (92.6% male, average age = 39.72) categorized as having single SUD (n = 39) or poly-SUD (n = 15). T-tests characterized group differences in baseline demographics and presenting symptomatology. Multilevel models examined differences in treatment trajectories between participants with single vs. poly-SUD. RESULTS: Groups did not differ on baseline frequency of substance use, PTSD symptoms, or treatment retention; however, individuals with poly-SUD evidenced greater reductions in percent days using substances than individuals with a single SUD, and individuals with a single SUD had greater reductions in PTSD symptoms than individuals with poly-SUD over the course of treatment. DISCUSSION: The findings from this exploratory study suggest that Veterans with PTSD and co-occurring poly-SUD, as compared to a single-SUD, may experience greater improvement in substance use but less improvement in PTSD symptoms during integrated treatment. Future research should identify ways to enhance treatment outcomes for individuals with poly-SUD, and to better understand mechanisms of change for this population. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/31009834/Veterans_with_PTSD_and_comorbid_substance_use_disorders:_Does_single_versus_poly_substance_use_disorder_affect_treatment_outcomes DB - PRIME DP - Unbound Medicine ER -